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OREGON HEALTH AUTHORITY,
PUBLIC HEALTH DIVISION

DIVISION 19

INVESTIGATION AND CONTROL OF DISEASES:
GENERAL POWERS AND RESPONSIBILITIES

333-019-0000

Responsibility of Public Health Authorities to Investigate Reportable Diseases

(1) The local public health administrator
shall use all reasonable means to investigate in a timely manner all reports of reportable diseases,
infections, or conditions. To identify possible sources of infection and to carry out appropriate
control measures, the local public health administrator shall investigate each report following
procedures outlined in the Authority's Investigative Guidelines or other procedures approved
by the Authority. The Authority may provide assistance in these investigations.

(2) Investigations of outbreaks
involving residents of multiple states or counties or exposures in multiple states of counties
may be supervised by the Authority.

(3) Investigations by the Authority
or public health administrator shall be conducted in accordance with ORS 433.004.

[Publications: Publications referenced
are available from the agency.]

(1) Health care providers, health
care facilities, and licensed laboratories shall cooperate with local public health administrators
and the Authority in the investigation and control of reportable diseases and conditions.

(2) Every health care provider attending
a person with a reportable disease, infection, or condition shall instruct the person in measures
appropriate to controlling the spread of the disease.

Providing Information to
the Oregon Health Authority or Local Public Health Administrator

(1) The Authority or local public
health administrator (LPHA) may, as necessary to investigate a case of a reportable disease, disease
outbreak or epidemic, require a health care provider, public or private entity, or an individual
to permit the inspection or provide copies of information necessary to the investigation.

(2) Information that may be inspected
or provided to the Authority or LPHA includes but is not limited to:

(B) An individual who may be the potential
source of exposure or infection;

(C) An individual who has been or may
have been exposed to or affected by the disease; or

(D) A control.

(b) Policies, practices, systems
or structures that may have affected the likelihood of disease transmission.

(c) Factors that may influence an
individual's susceptibility to the disease or likelihood of being diagnosed with the disease.

(3) In addition to requesting information
the Authority or LPHA may inspect, sample or test real or personal property. The Authority or LPHA
will request permission to inspect, sample or test real or personal property prior to taking any
action. If an individual or entity refuses to allow access to real or personal property for this
purpose, the Authority or LPHA may seek an administrative warrant in order to obtain access.

(4) The Authority or LPHA shall request
the information required to be submitted orally or in writing and shall inform the individual or
entity from whom the information is sought when the information is required to be submitted. In
lieu of requesting that information be provided to the Authority or LPHA, the Authority or LPHA
may request access to the information at the location where the information is located.

(5) A person who provides information
in accordance with these rules is immune from civil or criminal liability that might otherwise
be incurred or imposed with respect to providing information under this section.

(6) Pursuant to ORS 433.008, all information
obtained by the Authority or LPHA in the course of an investigation is confidential, may only be
released in accordance with ORS 433.008(2) through (6), and except as required for the administration
of public health laws or rules, a state or local public health official or employee may not be examined
in any administrative or judicial proceeding about the existence or contents of a reportable disease
report or other information received by the Authority or LPHA in the course of an investigation
of a reportable disease or disease outbreak.

The Authority may conduct special
studies concerning the causes and prevention of diseases and other significant health conditions.
Special studies include any collection of information about the health status or potential health
risk factors of individuals or groups of individuals, other than the routine collection of birth,
death, and marriage information, and are not restricted to reportable diseases, infections,
or conditions. The Authority may collaborate with local public health authorities, other institutions,
or other individuals in the conduct of these studies.

(a) As applied to food service
facilities includes but is not limited to diphtheria, measles, Salmonella enterica
serotype Typhi infection, shigellosis, Shiga-toxigenic Escherichia coli (STEC) infection,
hepatitis A, tuberculosis, open or draining skin lesions infected with Staphylococcus
aureus or Streptococcus pyogenes, and any illness accompanied by diarrhea or vomiting.

(b) As applied to schools,
child care, and health care facilities, includes but is not limited to chickenpox,
mumps, pertussis, rubella, and scabies and may include a communicable stage of hepatitis
B infection if, in the opinion of the local health officer, the child poses an unusually
high risk to other children (for example, exhibits uncontrollable biting or spitting).

(2) To protect the public
health, persons who attend or work at schools or child care facilities or who work
at health care facilities or food service facilities shall not attend or work at
these facilities whilst in a communicable stage of any restrictable diseases unless
authorized to do so as hereunder specified.

(3) At the discretion of
local school authorities or the local public health authority, pediculosis may be
considered a school-restrictable condition.

(4) A child or employee in
any school or children’s facility who has been exposed to a restrictable disease
must be excluded by the administrator, as that term is defined in ORS 433.235, unless
the local health officer determines, in accordance with section (5) of this rule,
that exclusion is not necessary to protect the public’s health.

(5) An administrator may
request that the local health officer determine whether an exclusion under section
(4) of this rule is necessary. In making such a determination the local health officer
may, in consultation as needed with the Authority, consider factors including but
not limited to the following:

(a) The severity of the disease;

(b) The means of transmission
of the disease;

(c) The intensity of the
child’s or employee’s exposure; and

(d) The exposed child’s
or employee’s susceptibility to the disease, as indicated by:

(A) A previous occurrence
of the disease;

(B) Vaccination records;

(C) Evidence of immunity
as indicated by laboratory testing;

(D) Year of birth; or

(E) History of geographic
residence and the prevalence of the disease in those areas.

(6) The length of exclusion
under section (4) of this rule is one incubation period following the child or employee’s
most recent exposure to the disease.

(7) A child or employee may
be excluded under this rule notwithstanding any claim of exemption under ORS 433.267(1).

(8) Nothing in these rules
prohibits the adoption of more stringent rules regarding exclusion from schools
or child care facilities. Such additional restrictions shall require formal certification
that the disease or condition in question presents a significant public health risk
in that setting. For schools, this action may be taken by the local public health
authority or the local school governing body. For child care facilities, this action
may be taken by the local public health authority.

(9) The infection control
committee at all health care facilities shall adopt policies to restrict the work
of employees with restrictable diseases in accordance with recognized principles
of infection control. Nothing in these rules prohibits health care facilities or
the local public health authority from adopting additional or more stringent rules
for exclusion from these facilities.

(1) Worksite, child care, and school
restrictions can be removed by statement of the local public health administrator
that the disease is no longer communicable to others or that adequate precautions
have been taken to minimize the risk of transmission.

(2) School or child care
restrictions for chickenpox, scabies, staphylococcal skin infections, streptococcal
infections, diarrhea, or vomiting may also be removed by a school nurse or health
care provider.

(3) Restrictions at health
care facilities for chickenpox, scabies, staphylococcal skin infections, streptococcal
infections, diarrhea, or vomiting may also be removed by the facility's infection
control committee when sufficient measures have been taken to prevent or minimize
the transmission of disease, in accordance with written procedures approved by the
committee.

(4) In general, restrictions
on persons diagnosed with shigellosis or Shiga-toxigenic Escherichia coli (STEC)
infection, including E. coli O157 infection shall not be lifted until no pathogens
are identified by a licensed laboratory in two consecutive approved fecal specimens
collected not less than 24 hours apart. Such restrictions may be waived or modified
at the discretion of the local public health administrator.

(5) Individuals infected
with Salmonella enterica serotype Typhi (with or without symptoms), hereinafter
referred to as "typhoid cases," must, before having a restriction removed, submit
fecal specimens and one urine specimen to a licensed laboratory for testing on a
schedule specified by the local public health administrator.

(6) A restriction on a typhoid
case who is not a chronic carrier must be lifted by the local public health administrator
when Salmonella enterica serotype Typhi is not identified by a licensed laboratory
in any of four successive approved fecal specimens, collected at least 24 hours
apart and not earlier than one month after illness onset, and one urine specimen.

(7) A “chronic carrier”
is an individual who has fecal specimens test positive for Salmonella enterica serotype
Typhi more than one year after onset or first diagnosis or on two occasions at least
one year apart. A restriction on a chronic carrier may only be removed when Salmonella
enterica serotype Typhi is not identified by a licensed laboratory in any of six
successive approved fecal specimens, collected at least 72 hours apart, and one
urine specimen.

(1) Except where specifically exempt, all dogs at least three months old shall be immunized against rabies by the age of six months. The following are exempt:

(a) Dogs brought temporarily into the state for periods of less than 30 days and kept under strict supervision by their owners;

(b) Dogs for which rabies immunization is contraindicated for health reasons, as determined by a licensed veterinarian subsequent to an examination. The reasons for the exemption and a specific description of the dog, including name, age, sex, breed, and color, shall be recorded by the examining veterinarian on a Rabies Vaccination Certificate, which shall bear the owner's name and address. The veterinarian shall also record whether the exemption is permanent, and if it is not, the date the exemption ends;

(c) Dogs that are owned by dealers, breeders, or exhibitors exclusively for sale or exhibition purposes and that are confined to kennels except for transportation under strict supervision to and from dog shows or fairs.

(2) Vaccination of an animal against rabies is valid only when performed:

(a) By a licensed veterinarian as specified by ORS 686.350 through 686.370 and OAR 875-010-0006;

(b) By a veterinary technician (certified according to OAR 875-030-0010) under the direct supervision of a licensed veterinarian; or

(c) In the case of a need to vaccinate and the lack of an available veterinarian, by another person approved for this purpose by the State Public Health Veterinarian.

(3) To be considered immunized against rabies, dogs and cats must be vaccinated according to guidelines published by the U.S. Centers for Disease Control and Prevention in the Compendium of animal rabies prevention and control, MMWR April 18, 2008; 57 (No. RR-2).

(4) A Rabies Vaccination Certificate shall be completed and signed by a licensed veterinarian; electronic signatures are acceptable. That individual shall give the original and one copy to the dog's owner and retain one copy for the period for which the vaccination is in force. The Certificate must include at least the following information: owner's name and address; dog description by age, sex, color, breed; date of vaccination; due date for revaccination; type and lot number of vaccine used; and name and address of vaccinator.

[Publications: Publications referenced are available from the agency.]

(1) Each dog shall be licensed by the local animal control agency in whose jurisdiction its owner resides.

(2) No dog shall be licensed until the owner of a vaccinated dog presents, in person or by mail, the original Rabies Vaccination Certificate to the County Clerk or designated animal control officer serving that jurisdiction.

(3) Upon receipt of applicable fees (if any, pursuant to ORS 433.380), the local animal control agency shall issue a serially numbered tag legibly identifying an expiration date that may not exceed the vaccine coverage expiration date by more than two months. The tag shall be attached to a collar or harness that shall be worn by the dog at all times when off the premises of the owner.

(4) The local animal control agency may request and file the Rabies Vaccination Certificate, cross-referenced to the tag number.

(5) An unexpired tag shall be honored throughout Oregon.

(6) A dog's rabies vaccination tag may, at the discretion of the local animal control agency, serve as the dog license, but not for more than two months beyond the immunity expiration date.

(7) Nothing in these rules shall be construed to limit the power of any jurisdiction to enact more stringent requirements to regulate and control dogs.

For the purposes of dog licensing, immunization, and response to bites, wolf-dog hybrids shall be considered wild animals and not dogs. The status of an animal as a dog or as a wolf-dog hybrid shall be determined by a Licensed Veterinarian. Such determinations may consider descriptions of the animal in medical records and prior claims made by the owner, and shall be subject to review by the State Public Health Veterinarian or designee.

(1) The circumstances surrounding
bites of humans by mammals shall be investigated by the local public health administrator in accordance
with the Investigative Guidelines published by the Authority.

(2) Except as provided in section
(3) of this rule, any dog, cat, or ferret that has bitten a person shall be held for observation until
the 10th day following the bite. This observation shall be under the supervision of a licensed veterinarian
or other person designated by the local public health administrator. Animals shall be held within
an enclosure or with restraints deemed adequate by the local public health administrator to prevent
contact with any person or other animals. At the discretion of the local public health administrator,
properly vaccinated dogs used by public law enforcement agencies may be exempted from the observation
period requirement; however, any law enforcement agency shall notify the local public health
administrator immediately should any exempted dog develop abnormal behavior within 10 days of
biting a person.

(3) The local public health administrator
may order the euthanasia and rabies testing of animals that have bitten humans when these animals
are:

(a) Inadequately vaccinated dogs,
cats, or ferrets that have inflicted an unprovoked bite to the face, head, or neck of a person; or

(b) Any other mammal suspected of
having rabies or that has been in contact with an animal suspected of having rabies.

(4) Because it is preferable to hold
such animals for observation, no person shall either euthanize any dog, cat, or ferret that has
bitten a human or destroy the head of any mammal that has bitten a person without authorization by
the local public health administrator.

[Publications: Publications referenced
are available from the agency.]

(1) An animal is considered to have been in close contact with an animal suspected of having rabies when, within the past 180 days, it has been bitten, mouthed, mauled by, or closely confined with a rabid animal or any mammal suspected of having rabies.

(2) The disposition of such animals and of animals suspected of having rabies that have not bitten humans shall be determined by the local public health authority as follows:

(a) Inadequately vaccinated dogs, cats, and ferrets shall be destroyed immediately, if the owner permits. If the owner does not agree to this, the animal shall be confined as prescribed by the local public health authority for a period of six months under the observation of a licensed veterinarian or a person designated by the local public health authority. It should be vaccinated against rabies one month before release.

(b) Dogs, cats, and ferrets that are adequately vaccinated shall be revaccinated immediately and observed in confinement for 45 days by a person designated by the local public health authority. If the owner prefers, such animals can be destroyed (in lieu of confinement) with the concurrence of the local public health authority.

(c) Unless the owner prefers to hold any unvaccinated livestock or wild animals born and raised in captivity in confinement for six months, such animals shall be destroyed.

(d) Unless otherwise specified, all other mammals shall be destroyed.

(e) For the purposes of this rule, confinement shall be within an enclosure or with restraints deemed adequate by the local public health authority to prevent contact with any member of the public or any other animal. Nothing in these rules or in OAR 333-019-0024 shall be interpreted to require any public authority to bear the costs of such confinement.

(3) Nothing in these rules is intended or shall be construed to limit the power of any city, city and county, county or district in its authority to enact more stringent requirements to regulate and control animals within its jurisdiction.

Investigation of cases of HIV infection
or AIDS. Investigations of HIV infection or AIDS shall be conducted to the extent
that resources permit. The Authority, or the local public health administrator,
will ensure that each identified case is offered prevention, care, and partner counseling
and referral services.

NOTE: Specific rules regarding reporting
requirements for HIV and AIDS may be found in OAR 333-018-0015. Rules regarding
informed consent for HIV testing and confidentiality of HIV test results may be
found in OAR 333-022-0200 through 333-022-0315.

(1)(a) Blood samples drawn from women during pregnancy or at delivery pursuant to ORS 433.017 shall be submitted for standard tests for reportable infectious diseases or conditions which may affect a pregnant woman or fetus. Routine tests submitted shall include syphilis, hepatitis B, and HIV. Tests using bodily fluids other than blood that have equal or better sensitivity and specificity may be substituted for the blood test.

(b) "Consent of the patient to take a sample of blood" (as stated in ORS 433.017, section 3) or other bodily fluid, is defined as notifying the patient or her authorized representative of the tests which will be conducted on that specimen. The patient or her authorized representative shall be informed that she may decline any or all of the tests.

(c) If a patient declines any of the offered tests, documentation shall be included in the medical record.

(2) Any health care provider attending the birth of an infant shall evaluate whether the newborn is at risk for gonococcal ophthalmia neonatorum. The primary means of assessing risk shall be review of results of prenatal testing and maternal history of risk factors for gonococcal. If the infant is determined to be at risk, or risk cannot be adequately assessed, the person attending the birth shall ensure that the newborn receives erythromycin or tetracycline ophthalmic ointment or silver nitrate 1 percent aqueous solution into each eye within two hours after delivery.

(1) In compliance with ORS 431.120(4),
the Authority will conduct an epidemiologic investigation of each instance of sudden infant death
syndrome.

(2) In order to promote support of
this effort, the Authority will reimburse any county health department (or other agency providing
public health services in lieu of a county health department for this purpose) to the extent of $25
to help defray the cost of one home visit by a public health nurse to any family who has lost a member
of the family to SIDS.

(3) In order for the home visit to be
reimbursed the following procedure will be required:

(a) On receiving the death investigation
report in which the cause of death is SIDS, the administrator of the local public health authority
receiving the report will, if possible, assure the arrangement of a home visit to the affected family
by a public health nurse at an appropriate time;

(b) The home visit will include:

(A) A nursing assessment of family
needs related to the SIDS event;

(B) Grief counseling;

(C) Education regarding the state
of knowledge regarding the cause of SIDS;

(D) Discussion of other support resources
available to help meet family needs;

(E) Information alerting the family
to expect to receive in the mail an epidemiologic investigation questionnaire, including an explanation
of its purpose, of its confidentiality, and assurance of assistance in completing the form if necessary.

(4) After the home visit has been completed,
the local agency will notify the Authority in writing, including the name and birth date of the deceased
infant, and the family name and address, and the date of the visit. This notice should be addressed
to the Public Health Division, Center for Public Health Practice, 800 NE Oregon Street,
Portland, OR 97232.

(5) On receipt of this written notice,
the Authority will reimburse the agency in the amount of $25. Reimbursement for repeat visits to
the same family will not be available.

(6) An epidemiologic questionnaire
will be mailed by the Authority to the parent(s) (guardian) of the deceased infant, with instructions
as to its purpose and means of completing and a request that it be completed and returned.

(7) In the event that the completed
questionnaire has not been returned in a reasonable length of time, the Authority will notify the
county health department (or agency acting in lieu of the county health department) with a request
for a follow-up contact with the family to ensure the highest possible rate of return and of accuracy.

(8) Completed questionnaires will
be collected and tabulated and the information analyzed by the Authority. A report of the findings
will be published biennially beginning in 1985.

(1) Each health care facility
shall formally assess the risk of tuberculosis transmission among staff (professional
and volunteer), residents, and patients at least annually and shall follow tuberculosis
screening recommendations outlined in "Guidelines for preventing the transmission
of Mycobacterium tuberculosis in Health-Care Settings," published by the Centers
for Disease Control and Prevention (Morbidity and Mortality Weekly Report, Vol.
54, Number RR-17: 1-141; December 30, 2005) or otherwise approved by the Authority.
For the purposes of this rule “health care facility” has the meaning
given that term in ORS 442.015.

(2) Each facility specified
below shall formally assess the risk of tuberculosis transmission among staff (professional
and volunteer), residents, and patients at least annually and shall follow appropriate
tuberculosis screening recommendations as outlined in the relevant publication or
as otherwise approved by the Authority:

(a) Long Term Care Facilities
for the Elderly: "Prevention and control of tuberculosis in facilities providing
long-term care to the elderly. Recommendations of the Advisory Committee for Elimination
of Tuberculosis," published by the Centers for Disease Control and Prevention (Morbidity
and Mortality Weekly Report, Vol. 39, RR-10, pp. 7-20; July 13, 1990) and "Guidelines
for preventing the transmission of Mycobacterium tuberculosis in Health-Care Settings,"
published by the Centers for Disease Control and Prevention (Morbidity and Mortality
Weekly Report, Vol. 54, Number RR-17: 1-141; December 30, 2005).

(b) Homeless Shelters: "Prevention
and control of tuberculosis among homeless persons," published by the Centers for
Disease Control and Prevention (Morbidity and Mortality Weekly Report, Vol. 41,
RR-5, pp. 13-23; April 17, 1992)

[Publications: Publications
referenced are available from the agency.]

(2) A correctional facility
shall screen all inmates upon admission for symptoms of tuberculosis (TB) disease.
This screening and any follow-up shall be documented.

(3) Any inmate suspected of
having TB disease or who has TB disease shall be isolated as appropriate and provided
medical care and treatment that meets accepted standards of practice.

(4) Inmates detained or confined
for 15 consecutive days or more in a correctional facility shall be screened for
the following TB risk factors:

(a) HIV/AIDS;

(b) Immigration within the past
five years from a country that has a high incidence of TB, including but not limited
to immigration from Africa, Asia, Middle East, Latin America, Eastern Europe and
South Pacific regions;

(c) Close contact to a person
with infectious TB disease;

(d) History of injection drug
use;

(e) History of homelessness;
and

(f) Taking immunosuppressive
medication.

(5) Inmates screened under section
(4) of this rule who have TB risk factors and no documented history of prior positive
screening tests for TB shall be screened with either a TB skin test or interferon
gamma release assay (IGRA). Inmates with a documented previously positive TB skin
test or IGRA, or a new positive result upon testing, shall receive a chest X-ray.

(6) Exceptions:

(a) A correctional facility
is not required to retest an inmate at each admission under section (5) of this
rule if:

(A) There is a documented record
of a negative TB skin test or negative IGRA or normal chest X-ray within the past
year; or

(B) There is a documented record
of adequate TB treatment or compliance with a currently prescribed TB treatment.

(b) This exception does not
apply if the inmate has symptoms of TB, evidence of new exposure to a person with
infectious TB disease or a diagnosis of HIV/AIDS.

(7) Nothing in these rules prohibit
any correctional facility from having more stringent TB screening requirements.

(C) A residential facility
or assisted living facility as those terms are defined in ORS 443.400;

(D) An adult foster home
as that term is defined in ORS 443.705;

(E) A hospice program as
that term is defined in ORS 443.850; and

(F) Any other facility that
provides 24-hour patient care.

(b) “Multidrug-resistant
organism” (MDRO) means an organism causing human disease which has acquired
antibiotic resistance, as listed and defined in the Centers for Disease Control
and Prevention’s Antibiotic Resistance Threats in the United States, 2013
(Atlanta, GA; 2013). MDROs include but are not limited to:

(A) Methicillin-resistant
Staphylococcus aureus (MRSA);

(B) Vancomycin-resistant
Enterococcus (VRE);

(C) Carbapenem-resistant
Enterobacteriaceae (CRE), as that term is defined in OAR 333-017-0000 sections (10)
and (24);

(c) “Receiving facility”
means the facility receiving or admitting the case patient into their care from
another facility’s care.

(d) “Referring facility”
means the facility transferring or discharging the case patient out of its care
and into another facility’s care.

(e) “Standard Precautions”
means the minimum infection prevention measures that apply to all patient care,
regardless of suspected or confirmed infection status of the patient, in any setting
where healthcare is delivered. Standard Precautions include:

(E) Safe handling of potentially
contaminated equipment or surfaces in the patient environment.

(f) “Transmission Based
Precautions” means infection control practices that are implemented in addition
to Standard Precautions in patients with known or suspected colonization or infection
of highly transmissible or epidemiologically important infectious pathogens (for
example, CRE, norovirus, Neisseria meningitidis) or syndromes (for example, diarrhea)
when there is strong evidence that the pathogen or syndrome may be transmitted from
person to person via droplet, contact, or airborne routes in healthcare or non-healthcare
settings (Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection
Control Practices Advisory Committee. Guideline for Isolation Precautions: Preventing
Transmission of Infectious Agents in Healthcare Settings, 2007).

(2) When a referring facility
transfers or discharges a patient who is infected or colonized with a multidrug-resistant
organism (MDRO) or pathogen which warrants Transmission Based Precautions, it must
include written notification of the infection or colonization to the receiving facility
in transfer documents. The referring facility must ensure that the documentation
is readily accessible to all parties involved in patient transfer (for example,
referring facility, medical transport, emergency department, receiving facility).

(3) When a facility becomes
aware that it received in transfer one or more patients with an MDRO or pathogen
that warrants Transmission Based Precautions, and that was isolated from a patient
specimen collected within 48 hours after transfer, it must notify the referring
facility.

(4) When a facility becomes
aware that it transferred or discharged one or more patients who have an MDRO or
pathogen that warrants Transmission Based Precautions, the referring facility must
notify the receiving facility.

(5) If a facility transfers
or discharges a patient with laboratory-confirmed, carbapenemase-producing Enterobacteriaceae,
the facility must notify the local health department communicable disease staff
within one working day of the date and destination of the transfer or discharge.

The official copy of an Oregon Administrative Rule is
contained in the Administrative Order filed at the Archives Division,
800 Summer St. NE, Salem, Oregon 97310. Any discrepancies with the
published version are satisfied in favor of the Administrative Order.
The Oregon Administrative Rules and the Oregon Bulletin are
copyrighted by the Oregon Secretary of State. Terms
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